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A high risk of recurring cancer left Gillian Boothroyd with some dire choices a couple of years ago.

She could have had radiation therapy after lumps were removed from both her breasts — one tested harmless, the other malignant — and then wait, despite knowing that both her grandmothers died of cancer.

Or she could take the “radical” step, as one oncologist called it, of having both breasts removed in a preventive double mastectomy. That’s what the 54-year-old former lawyer did two years ago, and she chose to have breast reconstruction surgery the same day, emerging three hours after she went under anesthetic with “nice and perky breasts.”

“If you didn’t know, you’d think, ‘Whoa, those look pretty good.’

“Having been through what I’ve been through ... that’s a blessing,” said the forthright, mile-a-minute Boothroyd in a telephone interview.

Plastic surgeons want to get the message out that combining a mastectomy and breast reconstruction in one operation is an option for women who are otherwise healthy, don’t smoke and are not overweight.

Dr. Peter Lennox, the head of the University of B.C.’s breast reconstruction program and Boothroyd’s surgeon, explained that more than 90 per cent of all Canadian women who have mastectomies don’t have any reconstructive surgery, often because breast cancer hits them in their 70s and 80s.

But the tragedy, in his opinion, is that many women don’t know it’s possible, or that it’s covered by medicare.

“Not everybody is a candidate for breast reconstruction, and not everybody is going to want to have it. But it’s hard when you see somebody who’s had a mastectomy and lived with it for a number of years and then finds out that one of the options would have been reconstruction right from the beginning.

“They’re quite often very upset and angry. Those of us who do this kind of work want to minimize that,” Lennox said.

For Boothroyd, a married mother of two from the North Shore, the decision was clear.

“My physicality is not my commerce, if I could put it that way, so losing my breasts didn’t affect me that way. But I don’t want to be reminded of this journey. I wanted to put my life back on the route that I want for myself.

“Looking in the mirror and seeing a reminder ... I just couldn’t live with that. And I didn’t want my kids to have to deal with it.”

Boothroyd’s health history is complex. She had surgery in her 40s to combat thyroid cancer, a hip replacement due to arthritis, and two strokes. To make matters worse, a clerical error resulted in a biopsy recommendation from a 2007 mammogram going missing so that lumps in her breast were finally tested for cancer two years after they were noted by health workers.

“When it was breast cancer time and I started getting chopped up, I felt a bit like one of those utility turkeys in the freezer section of the store — missing a wing, missing a drumstick — and I thought, ‘Are they going to do any more?’

“As a 51-year-old woman, you’re losing an aspect of your sexuality. And as a 51-year-old woman, sexuality is an issue anyway.”

Oncologists used to advise women to wait five years after a mastectomy to make sure they were clear of cancer. That position is changing as researchers have found no difference in health outcomes between women who had immediate breast reconstruction and those who did not. Scientific papers from the United Kingdom published in 2011 and from Finland in 2005 found the incidence of both new tumours and cancer spreading beyond the breast were the same throughout the study groups, whether or not women had a reconstructive procedure.

However, one drawback to immediate reconstruction, notes Lennox, is that if radiation is later required, it can damage reconstructed tissue, leaving scarring and tightening.

A limiting factor is the availability of two surgeons at the same time — an oncologist to cut out the tumours, and a plastic surgeon to complete the operation.

“I call them the off-again, on-again team,” quipped Boothroyd.

This is available in Vancouver, Surrey and Kelowna now and will likely become more common in B.C. because of the number of plastic surgeons practising here, said Lennox.

Having one operation instead of two is less traumatic for the patient. And women who postpone reconstruction often face a long wait for the second surgery because it’s no longer a potentially life-saving operation like a mastectomy, Lennox added.

The advantage of two surgeons working as a team is that most skin and even nipples can be spared during the operation, making for a more natural-looking breast afterward. When women wait to have a later reconstruction with a saline or silicone implant, skin either has to be stretched or taken from elsewhere on the body to create a breast envelope. The other option, either immediately or later, is for the surgeon to move tissue from a woman’s back or stomach and use it to create a breast mound.

A BRA Day information session will take place on Wednesday at 6 p.m. in the Paetzold Auditorium at 890 West 12th Ave., through the main entrance to Vancouver General Hospital. Lennox and two other Vancouver plastic surgeons, Dr. Sheina Macadam and Dr. Nancy Van Laeken, will talk about current concepts and techniques in breast reconstruction.

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Mastectomy patients have options on surgery day

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